Pineapple

PINEAPPLE: PlGF IN EArly Pre-eclampsia Prediction in sierra Leone

THE PROBLEM TO ADDRESS

Availability of placental growth factor (PLGF) test results has been demonstrated to significantly reduce time to clinical confirmation of pre-eclampsia and is associated with a lower incidence of maternal adverse outcomes. Subsequently, National Institute of health and Clinical Excellence (NICE) supports use of PLGF as a clinically and cost-effective algorithm in the management of women at risk of pre-eclampsia.

Current PLGF testing requires venous blood sampling; however a new PLGF point-of-care test (PoCT) has become available which uses capillary blood has recently been developed. PoCT, already widely used in maternity, provides real time results, and eliminates the need for costly laboratory testing and infrastructure. It fits well within midwifery led assessment pathways, enabling risk stratification and appropriate triage of women to Obstetric led care, whilst avoiding unnecessary intervention and over medicalisation of pregnancy in lower risk women.

Pre-eclampsia is one of the commonest causes of maternal death in low-income settings, where diagnostic tests and healthcare provider training are lacking. In this context, a cheap, accurate, easy-to-use test enabling earlier detection and reducing time to treatment could significantly reduce maternal and neonatal deaths.

THE PROJECT

Hypertensive women between 24 and 37 weeks of pregnancy, admitted to PCMH will be eligible to be included, provided they are willing and able to provide written consent. Each woman will have a PoCT PlGF test, but the results will be blinded, so will not inform clinical management.

Our main study objectives are to:

To assess PoCT PlGF test performance for prediction of pre-eclampsia within two weeks recommended for delivery by health-care professional
To compare POCT PLGF performance with ‘miniPIERS’ calculator to identify pregnant women (>24 weeks’ gestation) who develop adverse maternal outcomes associated with pre-eclampsia
To assess PoCT PlGF test performance according to gestation (<34 weeks’ / <37 weeks’)
To determine number of eligible women and time needed for study and analysis
To assess acceptability of POCT PLGF testing to health care professionals

Research Publications

Placental growth factor testing for suspected pre-eclampsia: a cost-effectiveness analysis
KE Duhig, PT Seed, JE Myers, R Bahl, G Bambridge, S Barnfield, J Ficquet, JC Girling, A Khalil,, AH Shennan, LC Chappell, RM Hunter.
Accepted 10 June 2019. Published Online 17 July 2019.

Objective: To calculate the cost-effectiveness of implementing PlGF testing alongside a clinical management algorithm in maternity services in the UK, compared with current standard care.
Diagnostic Accuracy of Placental Growth Factor in Women With Suspected Preeclampsia. A Prospective Multicenter Study
Lucy C. Chappell, PhD; Suzy Duckworth, MBBS; Paul T. Seed, CStat; Melanie Griffin, MBChB; Jenny Myers, PhD; Lucy Mackillop, MA; Nigel Simpson, MBBS; Jason Waugh, MBBS; Dilly Anumba, MD; Louise C. Kenny, PhD; Christopher W.G. Redman, MBChir; Andrew H. Shennan, MD
Received April 15, 2013; accepted September 3, 2013.

Methods and Results: In a prospective multicenter study, we studied the diagnostic accuracy of low plasma PlGF concentration (<5th centile for gestation, Alere Triage assay) in women presenting with suspected preeclampsia between 20 and 35 weeks’ gestation (and up to 41 weeks’ gestation as a secondary analysis).
Placental growth factor testing to assess women with suspected pre-eclampsia: a multicentre, pragmatic, stepped-wedge cluster-randomised controlled trial
Kate E Duhig, Jenny Myers, Paul T Seed, Jenie Sparkes, Jessica Lowe, Rachael M Hunter, Andrew H Shennan, Lucy C Chappell, on behalf of the PARROT trial group
Lancet 2019; 393: 1807–18. Published Online April 1, 2019

Background: Previous prospective cohort studies have shown that angiogenic factors have a high diagnostic accuracy in women with suspected pre-eclampsia, but we remain uncertain of the effectiveness of these tests in a real-world setting. We therefore aimed to determine whether knowledge of the circulating concentration of placental growth factor (PlGF), an angiogenic factor, integrated with a clinical management algorithm, decreased the time for clinicians to make a diagnosis in women with suspected pre-eclampsia, and whether this approach reduced subsequent maternal or perinatal adverse outcomes.
The BMJ Awards 2020 Entry Form
Pregnant women can develop pre-eclampsia, a common and potentially serious complication. For the last 100 years, we have relied on measuring blood pressure and dipping their urine for protein. But the clinical presentation is varied, with complications occurring before diagnosis is confirmed. Conversely hypertension or proteinuria can occur without progression to pre-eclampsia.